The Brown University Alcohol Research Center on HIV (ARCH)
Peter M. Monti, Ph.D., Principal Investigator
Christopher Kahler, Ph.D., Scientific Director
Alcohol use contributes to morbidity and mortality associated with HIV in numerous ways
including (a) reducing antiretroviral medication adherence and efficacy, (b) contributing to worse
virologic outcomes and immune functioning, (c) exacerbating liver dysfunction and hepatitis coinfection, and (d) exacerbating neurocognitive deficits associated with HIV. In addition, alcohol use
among both HIV-infected and uninfected individuals is implicated in high-risk sexual behavior that
leads to HIV transmission. Given multiple pathways through which alcohol impacts HIV morbidity,
mortality and transmission, the Brown University ARCH provides an integrated, multifaceted,
interdisciplinary approach to forward science on alcohol/HIV interactions and inform clinical
approaches to caring for people living with HIV and efforts to prevent HIV transmission. The CARC
has 8 integrated parts: an Administrative Core, three Research Components, two Scientific Cores
(Virology and Biostatistics), a Pilot Projects Component, and an Education/Dissemination
Component.
Research Component 1 (Alcohol and HIV-Associated Brain Dysfunction) will use MRI-based
structural and metabolite neuroimaging methods to determine in a longitudinal study the extent to
which alcohol and its effects on liver function increase the direct subcortical and cortical effects of
HIV. The purpose of Research Component 2 is to conduct a randomized clinical trial in which heavy
drinking men who have sex with men, who receive their HIV primary care at Fenway Health in
Boston, are randomly assigned to treatment as usual TAU) or TAU plus a brief intervention to reduce
alcohol use (TAU-BI). The study evaluates the effects of the TAU-BI on alcohol use, adherence to
HIV medication regimens, engagement in high-risk sexual behavior, plasma HIV RNA levels, liver
function, and neurocognitive function over a 12- month follow-up. Research Component 3 tests
whether a single-session multiple risk motivational intervention (MI) can more effectively decrease
and maintain reduction in alcohol use, alcohol related problems, and sexual risk taking following
discharge from the Emergency Department than Brief Advice (BA). Baseline, MI, and BA are
administered in the ED. Follow-ups will be conducted at 3, 6 and 9 months. In addition, this study
addresses potential mediators (motivation to change risk taking, self-efficacy) of MI effects and
whether reductions in sexual risk associated with MI compared to BA are accounted for by reduced
drinking.
Through the activities of the Administrative and Scientific Cores and the Education/
Dissemination Component, the ARCH will serve as the nexus for integration of alcohol/HIV science
across proposed research components, innovative pilot projects, complementary studies, other
NIAAA Centers, and regional, national, and international research and clinical training programs
yielding and disseminating new insights into interactions between alcohol and HIV and into
interventions to reduce drinking among those with HIV and others at risk for transmission.